Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus


  • Diabetes Mellitus is an endocrine disorder diagnosed by chronic hyperglycemia (a fasting blood glucose > 126 mg/dl or a random blood glucose sampling > 200mg/dl
  • Type 2 Diabetes Mellitus individuals are resistant to insulin on peripheral tissue


  • In type 2 Diabetes Mellitus, the cell does not respond to insulin (resistant) & does not take glucose into the cell (insulin transports glucose into the cell)- think of insulin as a key that opens the door to let glucose (sugar) into the cell. In insulin resistance the key (insulin) does not work, therefore the body starts to produce less insulin


  • Metabolic defects in Type 2 Diabetes are: peripheral insulin resistance in muscle and fat, decreased pancreatic insulin secretion & increased hepatic glucose output


  • Risk factors for Type 2 Diabetes Mellitus are: aging, sedentary lifestyle & obesity


  • Major cause of insulin resistance is obesity


  • Clinical Manifestations: hyperglycemia that, if untreated, leads to: Macrovascular complications, microvascular complications, neuropathic complications, increase in LDL cholesterol levels, foot infections, poor wound healing, impotence, skin rashes, yeast infections


  • Treatment: Control blood glucose levels to prevent acute & chronic complications of Diabetes.


  • American Diabetes Association recommends a preprandial blood glucose level between 70-130 mg/dl & postprandial blood glucose levels less than 180 mg/dl for adults with Diabetes & HbA1c < 7%.


  • Metformin is usually the first line drug for treatment of Type 2 Diabetes Mellitus and can be used as monotherapy


  • Treatment also includes: Lifestyle changes- Diet, exercise, smoking cessation, daily foot care & medications.


  • Treatments must be individualized for each patient


  • Hyperosmolar coma is more common in Type 2 Diabetes Mellitus


Risk Factors

  • Family history (first-degree relative)
  • age greater than 45 years
  • Impaired fasting glucose
  • Delivery of baby weighing more than 9 pounds
  • Hypertension
  • Hyperlipidemia (HDL < 40 mg/dL men, <50 mg/dL women; triglycerides>250 mg/dL)
  • Obesity
  • Ethnicity: African American, Hispanic American, Native American, Asian American, Pacific Islander


Pharmacologic Agents Associated with iatrogenic hyperglycemia

  • Glucocorticoids
  • Hormonal therapies (oral contraceptives)
  • Immunosuppressants (tacrolimus & cyclosporine)
  • Nicotinic acid (Niacin)
  • Antiviral HIV protease inhibitors
  • Several atypical antipsychotic agents (clozapine & olanzapine)
  • Beta-blockers
  • Calcium Channel blockers
  • Thiazide diuretics
  • Clonidine


Clinical Signs & Symptoms

  • Because the onset of diabetes usually occurs years before a diagnosis is made, patients are usually asymptomatic (Type 2 DM is usually insidious)
  • Symptoms of Type I & Type II DM are basically the same
  • The patient is often obese with a history of dyslipidemia, hypertension, & CAD
  • Neuropathic complaints: numbness & tingling
  • Increased urination, nocturia, thirst, or polydipsia
  • Vaginitis (candidiasis)
  • Skin infection
  • Hyperosmolar hyperglycemia syndrome (HHS) is severe dehydration resulting from prolonged hyperglycemia
  • HHS was formally known as hyperosmolar hyperglycemia nonketotic coma (HHNC)
  • HHS is associated with a high mortality rate

Diagnostic Criteria

  • Symptoms of DM Plus random plasma glucose concentration of 200 mg/dL or higher on two occasions
  • Fasting plasma glucose of 126 mg/dL or higher on two occasions.  Fasting is defined as no caloric intake for at least 9 hours
  • 2 hour post load glucose 200mg/dL or higher during an oral glucose tolerance test on 2 occasions. This test should be performed using a glucose load containing the equal event of 75 g  of anhydrous glucose dissolved in water.  This test is not recommended for a routine clinical diagnosis or in pregnancy.


Differential Diagnosis

  • Type I DM
  • IFG
  • genetic defects in insulin action
  • diseases of the pancreas
  • drug or chemical induced DM shit
  • Neurologic disorders that mimic diabetic neuropathy


  • Lifestyle modifications remain the initial management of type II DM (begin immediately on diagnosis of Type II DM
  • Exercise
  • Self monitoring of blood glucose
  • Pharmacologic therapy when lifestyle modifications & exercise are not effective

Complications of Type II DM

  • Retinopathy
  • Hyperlipidemia
  • Nephropathy
  • Hypertension
  • Macrovascular disease
  • Neuropathy
  • Psychosocial (↑stress, anxiety & guilt)



Dunphy, L.M., Winland-Brown, J. E. (2011). Primary Care: The Art and Science of

              Advanced Practice Nursing. Philadelphia, PA. F.A. Davis.


Uphold, C. R., & Graham, M. V. (2013). Varicella. In Clinical guidelines in family practice (pp. 243-246).     

 Gainesville, Fl: Barmarrae Books, Inc.